A short history of the light microscope
A brief history of microvascular surgery
Improvement of dexterity
Basic principles to master the techniques
Ethical aspects of the use of laboratory animals
 

A short history of the light microscope

"If we consider a microscope to be an instrument by which we can observe objects or parts of objects which are too minute to be visible to the naked eye, and which can be used to investigate minute structures of plants or animals, and thus bring to our knowledge facts not otherwise ascertainable, then the microscope is a comparatively modern invention and dates back only to about the end of the sixteenth century" (Clay and Court, 1975). However, magnifiers and "burning glasses" are mentioned in the writings Lucius Annaeus Seneca (4 BC-65 AC) and it is known that Nero (Lucius Domitius Ahenobarbus, AC 37- 68) used a lens made of emerald. 14th century Italian monks developed the art of grinding lenses (they were named lenses because they are shaped like the seeds of a lentil), but earlier Roger Bacon (1214?-1294) a monk in Oxford, used magnifying glass for reading.

1590: Hans and Zacharias Janssen (1580-1638) father and son, Dutch spectacle makers, produced the first compound microscope. The magnification ranged from 3 to 9x.
1625: Johannes Faber coined the term microscope (micron = ‘small’, scopos = ‘aim’ or skopein = ‘to look at’).
1665: Robert Hooke (1635-1703), an English scientist published Micrographia. Upon examination of the cork pores with his microscope, he decided to call them "cells".
1670: Antonie van Leeuwenhoek (1632-1723) of Holland, surveyor, cloth merchant and inventor of the modern microscope, reported his findings in over a hundred letters to the Royal Society of England. His lenses gave magnifications up to 270 diameters.
1674: George Ravenscroft vastly improved Antonio Neri’s glass formulations (1612).
1685: Cherubin d’Orleans (1613-1697) invented the binocular telescope (tele = 'far' and skopein=’ to see’ or ‘to look at’). (Galileo Galilei made his own telescope in 1609).
1744: John Cuff (1708-1792) built a metal microscope.
1872: Ernst Abbe (1840-1905) published his work on the theory of the microscope. His widely used formula to calculate resolution is based on his wave light theory.
1888: Carl Zeiss (1816-1888) marketed the apochromatic microscope objective.
1921: Carl Olof Nylén (1892-1978) used the microscope for a microsurgical operation in a case of chronic otitis - the birth of the otomicroscope and microsurgery. Nylén's microscope was replaced by a binocular microscope developed in 1922 by his colleague Gunnar Holmgren.
1953: The Carl Zeiss Company marketed the first modern operative microscope.

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A brief history of microvascular surgery

1877: Nikolai Eck (1847-1908) of Russia created a porto-caval shunt in a dog experiment. An important development that could be considered as the beginning of modern vascular surgery (Eck NV: Voen Med J 130: 1-2, 1877. Translated: Ligature of the portal vein. Child CG III Surg Gynecol Obstet 96:375-376, 1953).
1891: Alexander Jassinowsky of Odessa performed the first successful experimental arterial anastomosis on living animals (Jassinowsky A. Ein Bietrag zur Lehre von der Gefassnaht. Arch Klin Chir 1891; 22:816-41).
1897: The first arterial anastomosis in a human by John B. Murphy (1857-1916) in Chicago. (Resection of arteries and veins injured in continuity - end to end suture - experimental and clinical research. Med Rec (N.Y.), 1897, 51: 73-88.)
1912: Alexis Carrel (1873-1944) French surgeon was awarded the Nobel Prize in medicine and physiology for his work with vascular anastomosis.
1935: Gordon Murray (1894-1976, "the father of vascular surgery") introduced the anticoagulant heparin to world clinical practice.
1958: Sun Lee („the father of experimental microsurgery") of the Pittsburgh University described side-to-side portocaval shunt. Several microsurgical instruments were developed by him.
1960: Jules Jacobson of the University of Vermont described microvascular surgery using a microscope to aid in the repair of blood vessels with 1.4 mm diameter. He was the first to point out the value of the operating microscope in small vessel repair.
1962: On May 23, Ronald A. Malt and Charles F. McKhann at the Massachusetts General Hospital performed the first replantation on a 12-year-old boy who had his right arm amputated in a train accident.
1964: Harry Buncke (considered to be the "father of reconstructive microsurgery") reported the first successful rabbit ear replantation to the Plastic Surgery Research Council Meeting in Kansas (http://www.microsurgeon.org/history.htm). His monumental book "Microsurgery: Transplantation and Replantation" presents the state of the art of microsurgical replantation and transplantation in various areas of the body and for various clinical problems (see online: http://buncke.org/book/contents.html).
2005: Vascular microsurgery is a well established method in clinical practice and a promising new area for xenotransplantation (Robert Zhong), telesurgery and endoscopic surgery.

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Improvement of dexterity

    Generations of physicians were watching the world under the microscope with great fascination, describing each anatomical structure in its finest detail and observing the modifications produced by trauma or disease. The first clinicians who thought of manipulating this microscopic world who understanding the fact that finesse of hand movement is actually limited by eyesight. As a result, Carl Olof Nylén began the use of the operating microscope in year 1921, in which the birth certificate of microsurgery was signed. The operating microscope offers a magnified image that allows access to structures in the 0.3-1.2 mm range. In order to work in such a world, the surgeon must not only master, perfectly, microsurgical anatomy and physiology, but also acquire a technique that demands extreme precision and refinement. Just as a musician must start with the practice of scales and slowly progress towards complex scores, the surgeon must first acquire the fundamental technical principles in a laboratory before he can apply them clinically. Only after the techniques learned in the microscopic world have become second nature to the surgeon can he dare to practice his art and skill in reconstructive microsurgery. Though the laboratory experience is but a small part of the necessary process one undergoes in order to achieve clinical competence, it is a critical piece of microsurgical training. There must be a huge investment of tenacity, patience, and enthusiasm in order to fulfill the exacting technical demands presented by microsurgery. The satisfaction of successfully planning and executing a microscopic reconstructive intervention for the benefit of the patient represents a privilege that many are still trying to achieve.

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Basic principles to master the techniques

    Learning the basic principles of microsurgery requires at least an undisturbed week. This is the best and fastest way to acquire the skills, during this time one can indulge in the silence of the laboratory. Learning needs some basic environmental conditions, such as silence and calmness, or canceling the telephone and other disturbing factors (Yasargil 1969, Buncke 1975, Mehdorn 1987). The technique can not be taught in a running, overcrowded course. The technique itself is not sorcery at all, rather the ability to learn how to put simple and clear details together in our mind. In the first few days you will find the improvement slow or even frustrating, but sooner or later there comes the moment, when the picture begins to clear up. We should not forget that in this course we have to learn that the limits of the mistakes are measured in fragments of the millimeter. You should not be deterred by this; a patient attitude can always help to solve the problem. Our goal is mastery even though the achievement is sometimes slower. If something does not work, one should stop and solve the problem first.
    You should keep in mind that smoking deteriorates your concentration and performance for about 30 minutes, while drinking coffee can cause tremors. Lifting heavy weights, playing tennis or body-building aggravates the precise usage of fine muscles. The lack of sleep also seriously reduces the efficacy. It is important to avoid doing microsurgical exercises for longer periods without breaks; you should take a rest for 10 minutes in every working hour, if possible.

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Ethical aspects of the use of laboratory animals

    Microsurgical practice demands the assimilation of maneuvers and techniques of high skill and specialization that can only be learned by practice on a subject as clinically similar to the human being as possible. Thus, small laboratory animals have an important function in the process of learning basic microsurgical techniques. The first obligation of the researcher is to submit the animal only to "humane" treatment: one that will limit to a minimum both pain and suffering, and that will avoid producing any lesions that are not absolutely necessary. Experimental animals must receive proper pre-, intra-, and postoperative care. Practice animals, once anesthetized, should not be allowed to recover from anesthesia at the end of practice session. They should be euthanized.
    Attitudes toward the experimental use of animals vary widely and are sometimes based on concern and sometimes on ignorance and misinformation. Some individuals and groups, such as antivivisectionists, are against of all studies performed with animals as subjects. Though no country or society as a whole has accepted this extreme position, a greater stress has been placed, over the last decades, on the use of alternatives to animal subjects or the reduction of the number of animals used for experimentation. Although such methods have led to a drastic reduction in the number of animals used in research, the complete elimination of tests and experiments performed on animals is still not possible in the foreseeable future.

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